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Low C-reactive Protein and Urea Distinguish Primary Nonfunction From Early Allograft Dysfunction Within 48 Hours of Liver Transplantation

Primary nonfunction (PNF) is a life-threatening complication of liver transplantation (LT), but in the early postoperative period, it can be difficult to differentiate from early allograft dysfunction (EAD). The aim of this study was to determine if serum biomarkers can distinguish PNF from EAD in t...

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Autores principales: Halle-Smith, James M., Hall, Lewis, Hann, Angus, Arshad, Asif, Armstrong, Matthew J., Bangash, Mansoor N., Murphy, Nick, Cuell, James, Isaac, John L., Ferguson, James, Roberts, Keith J., Mirza, Darius F., Perera, M. Thamara P. R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10212614/
https://www.ncbi.nlm.nih.gov/pubmed/37250485
http://dx.doi.org/10.1097/TXD.0000000000001484
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author Halle-Smith, James M.
Hall, Lewis
Hann, Angus
Arshad, Asif
Armstrong, Matthew J.
Bangash, Mansoor N.
Murphy, Nick
Cuell, James
Isaac, John L.
Ferguson, James
Roberts, Keith J.
Mirza, Darius F.
Perera, M. Thamara P. R.
author_facet Halle-Smith, James M.
Hall, Lewis
Hann, Angus
Arshad, Asif
Armstrong, Matthew J.
Bangash, Mansoor N.
Murphy, Nick
Cuell, James
Isaac, John L.
Ferguson, James
Roberts, Keith J.
Mirza, Darius F.
Perera, M. Thamara P. R.
author_sort Halle-Smith, James M.
collection PubMed
description Primary nonfunction (PNF) is a life-threatening complication of liver transplantation (LT), but in the early postoperative period, it can be difficult to differentiate from early allograft dysfunction (EAD). The aim of this study was to determine if serum biomarkers can distinguish PNF from EAD in the initial 48 h following LT. MATERIALS AND METHODS. A retrospective study of adult patients that underwent LT between January 2010 and April 2020 was performed. Clinical parameters, absolute values and trends of C-reactive protein (CRP), blood urea, creatinine, liver function tests, platelets, and international normalized ratio in the initial 48 h after LT were compared between the EAD and PNF groups. RESULTS. There were 1937 eligible LTs, with PNF and EAD occurring in 38 (2%) and 503 (26%) patients, respectively. A low serum CRP and urea were associated with PNF. CRP was able to differentiate between the PNF and EAD on postoperative day (POD)1 (20 versus 43 mg/L; P < 0.001) and POD2 (24 versus 77; P < 0.001). The area under the receiver operating characteristic curve (AUROC) of POD2 CRP was 0.770 (95% confidence interval [CI] 0.645-0.895). The urea value on POD2 (5.05 versus 9.0 mmol/L; P = 0.002) and trend of POD2:1 ratio (0.71 versus 1.32 mmol/L; P < 0.001) were significantly different between the groups. The AUROC of the change in urea from POD1 to 2 was 0.765 (95% CI 0.645-0.885). Aspartate transaminase was significantly different between the groups, with an AUROC of 0.884 (95% CI 0.753-1.00) on POD2. DISCUSSION. The biochemical profile immediately following LT can distinguish PNF from EAD; CRP, urea, and aspartate transaminase are more effective than ALT and bilirubin in distinguishing PNF from EAD in the initial postoperative 48 h. Clinicians should consider the values of these markers when making treatment decisions.
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spelling pubmed-102126142023-05-26 Low C-reactive Protein and Urea Distinguish Primary Nonfunction From Early Allograft Dysfunction Within 48 Hours of Liver Transplantation Halle-Smith, James M. Hall, Lewis Hann, Angus Arshad, Asif Armstrong, Matthew J. Bangash, Mansoor N. Murphy, Nick Cuell, James Isaac, John L. Ferguson, James Roberts, Keith J. Mirza, Darius F. Perera, M. Thamara P. R. Transplant Direct Liver Transplantation Primary nonfunction (PNF) is a life-threatening complication of liver transplantation (LT), but in the early postoperative period, it can be difficult to differentiate from early allograft dysfunction (EAD). The aim of this study was to determine if serum biomarkers can distinguish PNF from EAD in the initial 48 h following LT. MATERIALS AND METHODS. A retrospective study of adult patients that underwent LT between January 2010 and April 2020 was performed. Clinical parameters, absolute values and trends of C-reactive protein (CRP), blood urea, creatinine, liver function tests, platelets, and international normalized ratio in the initial 48 h after LT were compared between the EAD and PNF groups. RESULTS. There were 1937 eligible LTs, with PNF and EAD occurring in 38 (2%) and 503 (26%) patients, respectively. A low serum CRP and urea were associated with PNF. CRP was able to differentiate between the PNF and EAD on postoperative day (POD)1 (20 versus 43 mg/L; P < 0.001) and POD2 (24 versus 77; P < 0.001). The area under the receiver operating characteristic curve (AUROC) of POD2 CRP was 0.770 (95% confidence interval [CI] 0.645-0.895). The urea value on POD2 (5.05 versus 9.0 mmol/L; P = 0.002) and trend of POD2:1 ratio (0.71 versus 1.32 mmol/L; P < 0.001) were significantly different between the groups. The AUROC of the change in urea from POD1 to 2 was 0.765 (95% CI 0.645-0.885). Aspartate transaminase was significantly different between the groups, with an AUROC of 0.884 (95% CI 0.753-1.00) on POD2. DISCUSSION. The biochemical profile immediately following LT can distinguish PNF from EAD; CRP, urea, and aspartate transaminase are more effective than ALT and bilirubin in distinguishing PNF from EAD in the initial postoperative 48 h. Clinicians should consider the values of these markers when making treatment decisions. Lippincott Williams & Wilkins 2023-05-24 /pmc/articles/PMC10212614/ /pubmed/37250485 http://dx.doi.org/10.1097/TXD.0000000000001484 Text en Copyright © 2023 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/) ), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Liver Transplantation
Halle-Smith, James M.
Hall, Lewis
Hann, Angus
Arshad, Asif
Armstrong, Matthew J.
Bangash, Mansoor N.
Murphy, Nick
Cuell, James
Isaac, John L.
Ferguson, James
Roberts, Keith J.
Mirza, Darius F.
Perera, M. Thamara P. R.
Low C-reactive Protein and Urea Distinguish Primary Nonfunction From Early Allograft Dysfunction Within 48 Hours of Liver Transplantation
title Low C-reactive Protein and Urea Distinguish Primary Nonfunction From Early Allograft Dysfunction Within 48 Hours of Liver Transplantation
title_full Low C-reactive Protein and Urea Distinguish Primary Nonfunction From Early Allograft Dysfunction Within 48 Hours of Liver Transplantation
title_fullStr Low C-reactive Protein and Urea Distinguish Primary Nonfunction From Early Allograft Dysfunction Within 48 Hours of Liver Transplantation
title_full_unstemmed Low C-reactive Protein and Urea Distinguish Primary Nonfunction From Early Allograft Dysfunction Within 48 Hours of Liver Transplantation
title_short Low C-reactive Protein and Urea Distinguish Primary Nonfunction From Early Allograft Dysfunction Within 48 Hours of Liver Transplantation
title_sort low c-reactive protein and urea distinguish primary nonfunction from early allograft dysfunction within 48 hours of liver transplantation
topic Liver Transplantation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10212614/
https://www.ncbi.nlm.nih.gov/pubmed/37250485
http://dx.doi.org/10.1097/TXD.0000000000001484
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